In a nutshell
This study investigated if sacubitril/valsartan is as effective as olmesartan in the treatment of hypertension.
They found that sacubitril/valsartan improved left ventricle mass and this was not as a result of reduced blood pressure.
Hypertension or high blood pressure can cause changes to occur in the cardiovascular system (heart and circulation). In particular, part of the heart wall called the left ventricle (LV) can increase in stiffness due to prolonged hypertension. This makes it more difficult for the heart to pump blood around the body.
Some drugs that are administered to lower blood pressure also have positive effects on the heart and vessels. Drugs called angiotensin receptor blockers (ARBs) reduce blood pressure and decrease arterial stiffness and changes in the structure of the LV. Olmesartan is an ARB that is effective at reducing blood pressure. Sacubitril/valsartan is a new drug that acts similarly by blocking angiotensin signaling but also blocks neprilysin. Blocking this peptide enzyme reduces stiffness in the LV.
Methods & findings
This study investigated if sacubitril/valsartan has any affect on LV remodeling in comparison to olmesartan.
114 patients with hypertension were included in this study. Patients were assigned to two groups: sacubitril/valsartan or olmesartan. Patients received either drug for 2 weeks initially and then a further 50 weeks at a dose of 400mg (sacubitril/valsartan) or 40mg (olmesartan) once daily. Blood pressure was measured and the structure of the heart wall and vessels was measured using magnetic resonance imagine (MRI).
Patients that received sacubitril/valsartan had greater improvement in the structure of the heart and vessels. The ability of the aorta to stretch was increased and the stiffness of the LV was reduced in patients taking sacubitril/valsartan. These structural improvements were observed at 12 weeks, before any evidence of blood pressure lowering was observed. Both sacubitril/valsartan and olmesartan reduced blood pressure, however there was no difference in effectiveness between these medications.
The bottom line
This study concluded that sacubitril/valsartan improved left ventricle mass and this was not as a result of reduced blood pressure.
The fine print
This study involved a small number of patients; larger studies are needed to confirm results. A larger proportion of the patients were male (68%).
If you have any questions regarding anti-hypertensive medication, please discuss with your physician.
Published By :
European Heart Journal
Oct 03, 2017